allopurinol and Water-Electrolyte-Imbalance

Tumor lysis syndrome is a potentially life threatening oncologic emergency that requires immediate medical intervention. The syndrome results from the destruction (or lysis) of a large number of rapidly dividing malignant cells spontaneously or during chemotherapy. The resulting metabolic abnormalities include hyperkaliemia, hyperuricemia, and hyperphosphatemia with secondary hypocalcemia, all of which put patients at risk for renal failure and alteration in cardiac function. The tumor lysis syndrome occurs most often in patients with large tumor burdens that are very sensitive to chemotherapy and radiotherapy, such as acute or chronic leukaemias with high leukocyte counts and high-grade lymphoma. The current standard management for tumor lysis syndrome consists of allopurinol or recombinant urate oxidase for high risk patient in conjunction with i.v. hydratation with or without alkalinization.

Topics: Acute Kidney Injury; Allopurinol; Antimetabolites; Fluid Therapy; Humans; Tumor Lysis Syndrome; Water-Electrolyte Imbalance

Tumour lysis syndrome (TLS) describes the metabolic derangements that occur with tumour breakdown following the initiation of cytotoxic therapy. TLS results from the rapid destruction of malignant cells and the abrupt release of intracellular ions, nucleic acids, proteins and their metabolites into the extracellular space. These metabolites can overwhelm the body's normal homeostatic mechanisms and cause hyperuricaemia, hyperkalaemia, hyperphosphaetemia, hypocalcaemia and uraemia. TLS can lead to acute renal failure and can be life-threatening. Early recognition of patients at risk and initiation of therapy for TLS is essential. There is a high incidence of TLS in tumours with high proliferative rates and tumour burden such as acute lymphoblastic leukaemia and Burkitt's lymphoma. The mainstays of TLS prophylaxis and treatment include aggressive hydration and diuresis, control of hyperuricaemia with allopurinol prophylaxis and rasburicase treatment, and vigilant monitoring of electrolyte abnormalities. Urine alkalinization remains controversial. Unfortunately, there have been few comprehensive reviews on this important subject. In this review, we describe the incidence, pathophysiological mechanisms of TLS and risk factors for its development. We summarise recent advances in the management of TLS and provide a new classification system and recommendations for prophylaxis and/or treatment based on this classification scheme.

Topics: Allopurinol; Humans; Tumor Lysis Syndrome; Water-Electrolyte Imbalance

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but severe adverse drug reactions with high mortality. The use of corticosteroids and the management of complications (e.g. infection) in SJS/TEN remains controversial.. A retrospective study was performed among 213 patients with SJS/TEN who were hospitalized in our department between 2008 and 2018, to investigate the causative agents, clinical characteristics, complications, and prognoses of SJS/TEN mainly treated by systemic corticosteroids combined with intravenous immunoglobulin (IVIG).. The causative drugs of SJS/TEN in these patients mainly consisted of antibiotics (61/213, 28.6%), anticonvulsants (52/213, 24.4%), and nonsteroidal anti-inflammation drugs (24/213, 11.3%), among which carbamazepine was the most frequently administered drug (39/213, 18.3%). There were significant differences in the maximum dosage, time to corticosteroid tapering, and the total dosage of corticosteroid between the SJS group and the TEN group, as well as among the three groups (P = 0.000), whereas in the initial dose of corticosteroid was not statistically significant among the three groups (P = 0.277). In a series of 213 cases, 18.4 cases (8.6%) were expected to die based on the score for the toxic epidermal necrolysis (SCORTEN) system, whereas eight deaths (3.8%) were observed; the difference was not statistically significant (P = 0.067; SMR = 0.43, 95% CI: 0.06, 0.48). The most common complications were electrolyte disturbance (174/213, 81.7%), drug-induced liver injury (64/213, 30.0%), infection (53/213, 24.9%), and fasting blood sugar above 10 mmol/L (33/213, 15.5%). Respiratory system (22/213, 10.3%) and wound (11/213, 5.2%) were the most common sites of infection. Multivariate logistic regression analysis indicated that the maximum blood sugar (≥10 mmol/L), the time to corticosteroid tapering (≥12 d), the maximum dosage of corticosteroid (≥1.5 mg/kg/d), and the total body surface area (TBSA) (≥10%) were defined as the most relevant factors of the infection.. The mortality of patients in this study was lower than that predicted by SCORTEN, although there was no significant difference between them. Hyperglycemia, high-dose corticosteroid, and the TBSA were closely related to the infections of patients with SJS/TEN.

Topics: Acute Kidney Injury; Adult; Aged; Aged, 80 and over; Allopurinol; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Anticonvulsants; Blood Glucose; Body Surface Area; Chemical and Drug Induced Liver Injury; China; Cohort Studies; Drugs, Chinese Herbal; Female; Gastrointestinal Hemorrhage; Glucocorticoids; Gout Suppressants; Humans; Hyperglycemia; Hypertension; Immunoglobulins, Intravenous; Immunologic Factors; Klebsiella Infections; Male; Middle Aged; Pneumonia; Pulmonary Aspergillosis; Respiratory Tract Infections; Retrospective Studies; Risk Factors; Stevens-Johnson Syndrome; Survival Rate; Water-Electrolyte Imbalance; Wound Infection

Topics: Administration, Ophthalmic; Allopurinol; Anti-Bacterial Agents; Biopsy; Corneal Ulcer; Critical Care; Diagnosis, Differential; Disease Management; Female; Fluid Therapy; Gout Suppressants; Humans; Middle Aged; Rehydration Solutions; Skin; Stevens-Johnson Syndrome; Treatment Outcome; Visual Acuity; Water-Electrolyte Imbalance

The alterations of the water-electrolyte balance are among the commonest early complications of treatment in children with acute lymphoblastic leukaemia (ALL). A study was carried out in thirteen patients with ALL aged between 1.5 and 14 years. Four had high risk ALL and nine had standard risk ALL. All patients received intravenous epirubicin and vincristine, per os prednisone, allopurinol and bicarbonate, and intrathecal methotrexate and hydrocortisone. Venous blood was drawn before starting therapy and on days second and sixth of treatment in order to assay sodium, potassium, calcium, phosphate, magnesium, albumin, urea nitrogen, creatinine and uric acid concentrations. The following alterations were found: hyponatraemia in 4 cases, hypokalemia in 9, hypomagnesaemia in 9, hypocalcaemia in 11, hypophosphataemia in 9, hypouricemia in 3 and hyperuricaemia in 3 others. None of the patients developed acute renal insufficiency. These abnormalities could be due to the leukaemia itself or appear as a consequence of the remission induction treatment.

Topics: Adolescent; Allopurinol; Anions; Antineoplastic Combined Chemotherapy Protocols; Bicarbonates; Blood Urea Nitrogen; Cations; Child; Child, Preschool; Cohort Studies; Creatinine; Epirubicin; Female; Humans; Hydrocortisone; Male; Methotrexate; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisone; Remission Induction; Risk Factors; Serum Albumin; Uric Acid; Vincristine; Water-Electrolyte Imbalance

Topics: Allopurinol; Antineoplastic Agents; Child; Humans; Leukemia, Lymphoid; Male; Methylprednisolone; Prednisone; Uremia; Water-Electrolyte Imbalance

Total starvation is effective for acute weight reduction in obesity. However, in 200 patients, most of whom also had internal diseases, 8% exhibited sometimes severe complications, i.e. reversible cerebral ischemia in 3 hypertensive patients when the blood pressure was lowered to the normal range by natriuresis of fasting; breakdown of water and electrolyte homeostasis with circulatory collapse, vomiting and vertigo; acute crises of paroxysmal nocturnal hemoglobinuria and porphyria respectively and increase of transaminases up to 200 mu/ml, or cardiac arrhythmias. Relative (?) contraindications for total fasting appear to be clinical sings of arteriosclerosis such as vascular bruits, angina pectoris and intermittent claudication. In case of doubt, the method should only be used in hospital.

Topics: Acetone; Adult; Allopurinol; Arrhythmias, Cardiac; Diet, Reducing; Edema; Female; Humans; Ischemic Attack, Transient; Male; Middle Aged; Obesity; Spironolactone; Starvation; Transaminases; Urea; Water-Electrolyte Imbalance